Radiotherapy of cervix cancer.

Among the malignant tumors of womanish privy parts takes first seat.

Classification of cervix cancer by TNM:

T₀ — a tumor is not determined;

T_{is (in situ)} — carcinoma of in situ;

T₁ — carcinoma is limited by the cervix uteri;

T₂ — karcinoma is widespread outside the cervix uteri, does not ainjured the walls of pelvis and/or pass on a vagina to the its lower third, don’t infiltrated or infiltrated parametrium;

T₃ — carcinoma is widespread on lower third of vagina and/or spreads to the walls of pelvis, may to arise hydronephrosis (as a result injure ureter by tumor);

T₄ — a tumor is widespread on the mucous membrane of urinary bladder or rectum and/or spreads outside a small pelvis;

N₀ — there are not metastases in regionar lymph nodes;

N₁ — there are metastases in regionar lymph nodes;

M₀ — there are not distant metastases;

M₁ — there are distant metastases.

Radiotherapy cervix cancer. In 1938 Tod and Meredіt suggested to conduct computation doses in the performance of radiotherapy cervix cancer in the two conventional points –A and B, located at the level of internal pharynx of cervix uteri (see fig. 8.2.). Point A takes place on 2 sm of lateral middle axis of uterine channel. Point B takes place thereon level and is distant from the axis of uterus on 5 sm (area of lateral parametrium and lymphatic nodes of lateral wall of pelvis).

Fig. 8.2. Position of points A and B in small pelvis.

Stage of in situ (T_isN₀M₀) — surgical medical treatment: hysterectomy with the segment of vagina of with/without adnex depending on age; to the patients which have contra-indications to surgical medical treatment from extragenital pathology and yellow sear leaf, SBD 5 Gr intracavitary gamma-therapy (ICGT), TBD 50 Gy 2 – 3 sessions in a week by the hose gamma-therapy apparatus “Agat-V” (a radio-active package to the hearth of defeat is tricked into automatically without direct participation of personnel of separation of radio therapy).

Stage I (T₁N₀M₀) — the combined medical treatment: extripation uteruses, post-operation the EBGT shallow fractionating to SD 40 – 45 Gy in a point B.

Stage II (T₂N₀M₀) —combine radio therapy: EBGT TBD in a point A 20 – 25 Gy, in a point B 40 – 42 Gy by the shallow fractionating, ICGT TBD in a point A 50 Gy, SBD 5 Gy 2 – 3 times per a week, SD in a point B 12,5 Gy — TBD from both methods in a point A 75 Gy, in a point B 54,5 Gy; polychemicaltherapy is possible on occasion.

Stage III (T_1-3N₁M₀) —combine radio therapy by the split course: EBGT in two stages (a 1 stage of TBD in points A and B to 30 Gy, a 2 stage in 2 weeks of TBD in a point A 5 Gy, in a point B 16 Gy), ICGT the TBD in a point A 50 Gy, in a point B 12,5 Gy — TBD from both methods in a point A 85 Gy, in a point B 58,5 Gy; polychemicaltherapy is possible.

Stage IV (T_0-4N₁M₁) — palliative EBGT, palliative polychemicaltherapy.

The five-year survival after radio therapy of cervix cancer are: at the first stage to 90%, at the second stage – 60,2%, at to 3-her the stages – 35,6%. On the average for all stages of cancer of cervix uteri the five-year survival makes 58,5% cases.

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